9It’s GOOD in moderation!A word about sunshine . . .It’s GOOD in moderation!10-15 minutes dailyShort sleeves and pantsWithout hat or sunscreenSPF 15 or higher blocks 99% of UVBWhat about risk of skin cancer?Apply sunscreen after those first minutes!

10“It is virtually impossible to get enough sunshine from November to February above 35 degrees latitude* to stay “sufficient”.*35 degrees latitude is the north border of Georgia, Alabama, and Mississippi, and cuts Arkansas in half just north of Little Rock

15DATE: August 29, 2008It is clear that vitamin D content of human milk is variable and directly related to maternal vitamin D status. Human milk is not deficient in vitamin D per se; rather, it is deficient in vitamin D when mother is deficient. Vitamin D transfer into mothers’ milk is predictable: a deficient woman has little to transfer to her infant via her milk; if her status improves, transfer of vitamin D in her milk to the baby will also. Maternal vitamin D deficiency and resultant nutritional rickets in her nursing infant is preventable: supplementation of the infant with vitamin D will ameliorate deficiency in that age group, but does not address maternal needs. Adverse effects associated with vitamin D deficiency affect bone development and innate immunity such that no woman and her baby should be deficient. We must prescribe a safe intervention that will achieve sufficiency in both mother and infant and not blame human milk as the culprit, but rather, see the problem as the larger public health issue that it is.Caroline Chantry, MD Karla Shepard RubingerPresident Executive DirectorAcademy of Breastfeeding Medicine Academy of Breastfeeding Medicine140 Huguenot Street, 3rd floorNew Rochelle, NY

16Human Breast Milk is not deficient in Vitamin D; Modern life is deficient in sunshine!

20Risk Factors for Vit D deficiency in infantsMom who is “insufficient” or “deficient” during pregnancy or lactationBaby is both exclusively breastfedAND sheltered / protected from sunlight.Babies born in fall/winterBabies in full-time daycareLiving above 35 degrees N latitudeBabies born prematurely

22Supplementation of the nursing infant with oral vitamin DSupplementation of the nursing infant with oral vitamin D does not address the issue of why the antirachitic activity of the mother’s milk is low --- namely, that her vitamin D status is poor.Wagner CL, Taylor SN, and Hollis BW. Does Vitamin D Make the World Go ‘Round? Breastfeeding Medicine 2008; 3(4):

24“We understand more fully now that this deficiency is not caused by something that is inherently wrong or missing in mother’s milk but rather by inadequate maternal dietary vitamin D intake and the resultant low concentrations in the mother’s milk.”Wagner CL, Taylor SN, and Hollis BW. Does Vitamin D Make the World Go ‘Round? Breastfeeding Medicine 2008; 3(4):

25Supplementation of Breastfeeding Mothers“Lactating women given 4000 IU of vitamin D3 per day not only had an increase in the level of 25-OH vitamin D to more than 30 ng/ml, but were able to transfer enough vitamin D3 into their milk to satisfy an infant’s requirement.”Hollis BW, Wagner CL. Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant.Am J Clin Nutr 2004; 80:Suppl 6:1752S-1758S.

27SummaryVitamin D deficiency is much more widespread than previously thoughtVitamin D deficiency is a factor in many diseases, not only rickets and osteoporosis.Modern life is deficient in sunshine, and thus in vitamin D.Some form of vitamin D supplementation may be appropriate for many breastfeeding mothers / babies.

28Summary“In the future, we expect that by treating the mother with a sufficient dose of vitamin D, both mother and her recipient infant will achieve normal vitamin D status.”Wagner CL, Taylor SN, and Hollis BW. Does Vitamin D Make the World Go ‘Round? Breastfeeding Medicine 2008; 3(4):